Pediatric Informatics: Computer Applications in Child Health (Health ...

312 R.S. Gerstle
23.2 Issues in Patient–Physician Electronic
Communication 1–2
23.2.1 Reimbursement
Recently, the value of e-mail encounters has been recognized by selected insurers
by their willingness to allow billing for e-mail consultations with established
patients, subject to individual contract negotiation with the insurer. Interestingly,
insurers seem more amenable to reimburse pediatricians for e-mail “visits” then for
telephone care (which has long been a part of pediatric practice), perhaps because
of the inherent ability to “capture” documentation. Typically insurers have allowed
charges that typically reflect the patient’s office co-pay, usually resulting in little
or no actual cost to the insurer itself. Recently Current Procedural Terminology
(CPT 2008) 8 was updated to include a code specifically referencing direct e-mail
care or consultations.
99444 Online evaluation and management service provided by a physician to
an established patient, guardian, or health care provider not originating from a
related E/M service provided within the previous 7 days, using the Internet or
similar electronic communications network.
However, recognize that the availability of a CPT code for a procedure does not
automatically guarantee insurer payment for the procedure.
Secure messaging and charge capture
Some physician office portals allow capture of and charging for e-mail services
through online prepayment.
Charges for such online queries that require or result in a face-to-face visit can
be credited back to patients.
23.2.2 Liability and Appropriate Use of E-Mail
The appropriateness and limitations of e-mail use must be clearly communicated
and reiterated to patients. Suggestions to implement this include:
Using secured sites and portals
Require full identification of patients registered to the practice in all
transactions
Post policies and limitations of e-mail services
Use structured messages for a set of specific information or procedures: prescription
refills, referrals, school forms, etc
Posting specific information (“auto-reply”) on all outgoing messages
Note expected time of reply, including unavailability of personnel.
Use disclaimers for emergency care (“Call 911”).